The Impact of Behavior on Health Status, Longevity in the Southeast

Jan 23, 2018 at 02:55 pm by steve

UnitedHealthcare Annual Rankings Highlight Good & Bad

As Americans begin a new year filled with good intentions to kick bad habits, eat healthier and increase physical activity, United Health Foundation's annual America's Health Rankings® might serve as extra motivation to stick to those resolutions.

Once again, the Southeast falls to the bottom of overall health status linked to challenges with weight, inactivity, smoking and drug abuse. The 2017 report that was released last month ranks eight southeastern states in the bottom 10 with Tennessee, West Virginia, Alabama, Arkansas, Louisiana and Mississippi ranking 45-50, respectively.

Karen Cassidy, MD

Despite the obvious health concerns faced by the region, Karen Cassidy, MD, chief medical officer for UnitedHealthcare Commercial and Medicare for the Mid-South and Gulf States, said it was important to recognize that all states have both challenges and areas of leadership. Rather than feeling discouraged by a specific ranking, she said the goal is for healthcare providers, policymakers, public health officials and community partners to take a deep dive to look at trends and search for solutions.

Even among the healthiest states, there are significant issues threatening health and well-being. "From a national standpoint, we're seeing a rise in premature deaths," Cassidy said of the increase in the years of potential life lost before the age of 75. The premature death rate rose for the third straight year and marks a 3 percent increase from 6,976 to 7,214 years lost before age 75 per 100,000 population since 2015.

While the data doesn't pinpoint specific causes for the increase, a number of health trends are likely contributors including an upward tick in the rate of drug-related deaths, a second consecutive year of increased cardiovascular deaths, and continued high rates of obesity and of unhealthy behaviors. "As we've seen, obesity and diabetes rates are going up every year. I think that directly speaks to premature deaths ... you can't pull those apart," said Cassidy.

Alabama ranked 48th in the nation for premature deaths and 47th for obesity. "Diabetes is up 24 percent over five years," she said, adding nearly 15 percent of Alabamans are now diabetic.

Additionally, she noted, "We're seeing an unevenness in healthcare providers." For example, she said, Alabama had a large gap in mental health providers. Massachusetts, which came in as the healthiest state for the first time in the history of the rankings, had six times the number of mental health providers compared to Alabama, which had the fewest nationally. Massachusetts had 547 care providers per 100,000 people vs. Alabama with 85 care providers per 100,000. With drug-related deaths up 22 percent over a three-year period in Alabama, Cassidy said the need for mental health providers is even more acute to ensure those struggling with addiction have avenues to receive comprehensive care.

Similarly, Alabama had fewer than 44 dentists per 100,000 people compared to Massachusetts and New Jersey with more than 80 dentists per 100,000. The state also ranked 42nd for the number of primary care providers with 119.3 per 100,000 in population.

The state also had a number of positive trends. Alabama ranks among the best in the nation with a low prevalence of excessive drinking (#5), high rates of high school graduation (#3), smaller disparities in health status (#8), public health funding (#10) and immunizations for children (#7).

Cassidy said Alabama has seen an increase of 9 percent over a one-year period in childhood immunizations. "That's huge - 77 percent of children 35 months to age 19 are adequately immunized ... that's something to be proud of," she said. That type of movement in a short timeframe should catch the attention of policymakers in other areas, she noted. "When you see something like that, you look at best practices in Alabama ... it's one of the powerful things about this report."

Cassidy said it's also important to keep perspective even in areas where the Southeast lags. Despite still having higher smoking rates than other areas of the country, she pointed out, "Our rates are lower than they were 20 years ago so it is falling. It's just not falling as quickly as everywhere else."

Looking at the data in aggregate, behaviors seem to be the driver behind so many poor outcomes, including the national increase in premature deaths. "I think it should be a call to action for physicians across the country to be working on those preventable lifestyle choices very seriously," said Cassidy. With New Year's resolutions freshly made, she said it was a great time to initiate difficult conversations. Even when met with resistance, Cassidy added, it's important not to let a 'no' be the final answer when it comes to quitting smoking or losing weight. "I still think we have to reopen that conversation intermittently and let patients know you're ready to be there for them."

She was quick to add that many providers are already routinely talking to patients about the direct link between behaviors and health. Cassidy noted one way to take those conversations to the next level is to become familiar with available resources within the community and through a patient's health coverage. "Make sure you're really aware of the benefits your patients have," she advised. Cassidy added many plans have unique programs to help build healthy habits at no charge and have established partnerships locally to provide access to other resources like gym memberships at significantly reduced rates for health plan enrollees.

The takeaway from the annual America's Health Rankings report, Cassidy said, is to focus attention where it's most needed and to foster conversations and innovations to address needs within a state. "I don't want people to feel negative about a 'bad grade' and not be able to get past that and be able to use this information in a positive way," she noted.

"The more meaningful piece of this is focusing on where are the strengths and what are the challenges rather than getting hung up on the number," Cassidy concluded. "Let's use this data to make positive changes."

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